D5840.PDF

Rev. sci. tech. Off. int. Epiz., 2008, 27 (3), 751-758
A foot and mouth disease simulation exercise
involving the five Nordic countries
J.M. Westergaard (1), C.B. Andersen (2) & S. Mortensen (2)
(1) ADC-Consult, Mikkelborg Alle 7, DK 2970 Hørsholm, Denmark
(2) Danish Veterinary and Food Administration, Mørkhøj Bygade 19, DK 2860 Søborg, Denmark
Submitted for publication: 10 October 2006
Accepted for publication: 20 May 2008
Summary
Simulation exercises are considered a very valuable tool for testing contingency
plans established for the control and eradication of rapid spreading animal
diseases such as foot and mouth disease, classical swine fever and avian
influenza. An inter-Nordic simulation exercise was conducted in 2005 with the
objective of testing the national foot and mouth disease contingency plans
adopted respectively by Denmark, Finland, Iceland, Norway and Sweden. The
Central Veterinary Administrations of the five countries jointly prepared a
scenario which involved about 40 livestock holdings, 4 reindeer flocks, 6
slaughterhouses and approximately 500 people. An Excel spreadsheet with
information on the events to take place and the timetable to follow during the
exercise was a valuable tool for ensuring that the exercise was kept on track.
The evaluation of the exercise dealt both with inter-Nordic activities and the
activities of individual countries.
Keywords
Animal health – Cross-border collaboration – Foot and mouth disease – Inter-Nordic
activities – Simulation exercise.
Introduction
Preparation of the scenario
Foot and mouth disease (FMD) has been absent from the
Nordic countries for a number of years (Iceland: never
recorded; Norway: 1952; Finland: 1959; Sweden: 1966
and Denmark: 1983). The great economic losses caused by
FMD outbreaks in 2001 in Europe, the constant threat to
food-producing animals in FMD-free countries and the
potential for rapid spread of disease between countries
having close links in the agricultural sector, encouraged the
Nordic Council (the forum for parliamentary cooperation
between Nordic countries) to give financial support for an
inter-Nordic FMD simulation exercise in 2005. The
decision to carry out such an exercise was further
stimulated by the European Union (EU) FMD Directive
(3), which foresees that countries shall test National FMD
contingency plans by simulation exercises.
A simulation exercise working group with representatives
of the National Veterinary Administrations of the five
Nordic countries was established in 2004. The initial
meeting of the group dealt in particular with:
a) the aim of the exercise
b) the formulation of objectives relating to:
– inter-Nordic activities
– activities of individual countries in the light of the
prevailing animal production systems and training
requirements
c) the timetable for the preparation and conduct of the
exercise.
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It was agreed at the meeting that the aim of the exercise
was: ‘to test the Contingency Plan established by each
country for the control of foot and mouth disease’ and that
the timing of the exercise should only be known in
advance to the Chief Veterinary Officers (CVO) of each
country and the members of the working group. During
the implementation of the exercise most of the Members of
the working group were acting as ‘game masters’, i.e.
persons designated to ensure that the exercise was running
on schedule.
The working group met for preparatory work on five
occasions between October 2004 and September 2005;
each country was represented by two to three veterinarians
who all were engaged in contingency planning at the
national level. A consultant assisting the working group
was responsible for preparing the agenda for meetings and
for preparing working documents and meeting reports.
It was noted by the group that although simulation
exercises are widely recommended for improving the
preparedness for the occurrence of rapid spreading animal
diseases (the former List A diseases of the World
Organisation for Animal Health [OIE]), a definition of a
simulation exercise has not been agreed at International
level. For the purpose of the inter-Nordic simulation
exercise it was agreed that a simulation exercise should
mean: ‘an organised and controlled scenario-driven event
carried out with the aim of:
Rev. sci. tech. Off. int. Epiz., 27 (3)
– transport of diagnostic samples
– development of a policy for the transport of nonsusceptible animals such as horses and hunting dogs
– recruitment of foreign veterinarians
– administration of cross-border surveillance zones
– administration and surveillance of reindeer populations
migrating between countries.
The background documentation for the exercise was
generated in an Excel spreadsheet. The spreadsheet was
found to be an excellent tool for the preparation of a
scenario and for the game masters to coordinate the
proposed activities in the five countries whilst the exercise
was being conducted. The spreadsheet contained
– training personnel designated to be involved in an
emergency situation related to the control of potentially
rapid spreading animal diseases
– testing, reviewing and up-dating contingency plans,
disease eradication strategies and capabilities at local,
regional and/or national level’.
The definition adopted took into account experiences
gained from simulation exercises conducted in the spring
of 2004 in Denmark and in Iceland (7) and it was agreed
that the exercise should include field conditions (i.e. farms,
slaughterhouses) and that participants should work in
their normal working facilities and environment.
The scenario was based on a simulated spread of FMD
virus between the Nordic countries as shown in Figure 1.
The individual countries then developed additional
detailed national scenarios within the framework of the
inter-Nordic scenario.
The scenario included elements that required cross-border
collaboration between individual countries within different
areas relevant for disease eradication, including:
– information exchange at the level of the CVO
– epidemiological investigations
– use of an FMD model for airborne spread
Denmark, Finland, Iceland,
Norway and Sweden
km
Population:
0 to 50,000
50,000 to 500,000
500,000 to 1,000,000
1,000,000 and over
Capital
Fig. 1
Scenario of the inter-Nordic transmission of foot and mouth
disease virus
A Norwegian sheep farmer organised a workshop on specialised
production of cheese, wool and meat on his farm. Many other farmers
from the Nordic countries participated in the workshop and returned
home to their own farms with cheese products or fresh meat. At the
time of the workshop, the animals on the farm were incubating foot
and mouth disease, because five sheep of a special genetic breed with
a high milk production had been illegally imported from a country with
endemic FMD
Rev. sci. tech. Off. int. Epiz., 27 (3)
12 columns for placing information relating to: date, hour,
country/countries involved, event, initiator of activity,
responder, anticipated response, the element tested, name
of the file containing details about the event and the author
responsible for the text in a given row. At the time of the
start of the simulation exercise information had been
entered into 48 rows. Only the game masters were allowed
to enter data into the spreadsheet. A part of the spreadsheet
is shown in Figure 2.
Information on the conduct of the simulation exercise was
submitted to the OIE for further distribution to OIE
Member States (7).
Implementation
The simulation exercise was carried out from 19 to
23 September 2005 and it was possible for the game
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master team in each country to adhere to the established
timetable given in the Excel spreadsheet (Fig. 2). A liaison
officer was appointed in each team to coordinate the
activities performed in the different countries.
The scheduled cross-border collaboration between the
Nordic countries took place at both the level of the CVO
and on the sub-CVO level by use of phone calls, faxes,
emails and telephone conferences. In addition to the interNordic activities, the individual countries had the
opportunity to carry out activities which paid particular
attention to issues of national interest. Information on the
use of livestock holdings and persons involved in the
exercise is given in Table I, which also contains
information on issues tested by different countries.
The tasks performed in the field when FMD was suspected
involved the owners of farms, private veterinarians and the
official veterinarian. The measures applied or simulated
were those outlined in Section 2: ‘Measures in case of
Fig. 2
Inter-Nordic foot and mouth disease simulation exercise 2005: a spreadsheet was developed to describe the scenario and the timing
of the introduction of each new element during the simulation exercise
Each row represents a significant event. Columns A and B specify the date and hour at which an activity should to be initiated, column C specifies in
which country, column D provides information on the event, columns E and F describe who will initiate the event and who should respond. Columns G
and H describe which section of the contingency plan is being tested and column I links to the documents handed out to the participants in the
exercise, e.g. a made-up laboratory test result
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Rev. sci. tech. Off. int. Epiz., 27 (3)
Table I
Inter-Nordic foot and mouth disease simulation exercise 2005: information on the scope of the exercise with regard to livestock
holdings and persons involved and issues given special attention by individual countries
Countries
Number of livestock
holdings and industries
involved
Persons involved
Issues given special attention at national level
Denmark
Pigs (14)
Sheep and goats (5)
Cattle (3)
Livestock markets (1)
Slaughterhouses (3)
>200
Finland
Cattle (8)
Pigs (2)
Reindeer flocks (3)
Slaughterhouses (1)
>80
–
–
–
–
operation of national disease control and local disease control centres
disease suspicion and confirmation
milk collection
contact with the media
Iceland
Sheep (1)
Slaughterhouses (1)
>15
–
–
–
–
operation of national disease control centre
disease suspicion
transport of infectious material by air
review of legislation and contingency plan
Norway
Sheep (1)
Cattle (1)
Pigs (1)
Reindeer flocks (1)
Slaughterhouses (1)
>150
–
–
–
–
operation of national disease control and local disease control centres
disease suspicion
disease confirmation
contact with the media
Sweden
Cattle (2)
Pigs (1)
Slaughterhouses (1)
>50
suspicion of an outbreak of foot-and-mouth disease’ in
Council Directive 2003/85/EC (3). The owners of herds in
which disease was suspected, and the private veterinarians
who would normally provide veterinary assistance to the
herds, had been contacted two to three months prior to the
exercise to ensure their:
– willingness to participate in the simulation exercise
– promise of secrecy with regard to date of disease
suspicion
– disease suspicion and confirmation
– stamping out
– cooperation between Central Veterinary Administration and external
institutions and organisations
– trade issues
– air-borne spread
– emergency vaccination
– operation of national disease control centre
– disease suspicion
– disease confirmation
national FMD reference laboratory in Denmark.
The samples from Iceland were initially refused by the
airline due to the labelling of the parcel, in spite of the fact
that the Central Veterinary Administration of Iceland had
obtained assistance from a recognised transport company,
which operates worldwide. In general, the involvement of
the laboratories was limited to receiving samples from the
field, as outlined in the scenario, and no attempt was made
in this exercise to determine the capacities of the national
reference laboratories.
– agreement on remuneration.
On the day of the visit by the practicing veterinarian, the
owner of an FMD suspected herd handed over to the
veterinarian a letter which contained information on the
signs of FMD and photos of lesions. The information
received in the letter was used by the practicing
veterinarian at the moment a call was made to the official
veterinarian concerning the suspicion.
In-depth epidemiological investigation is of paramount
importance for controlling FMD, so epidemiological
investigations were carried out at all farms when disease
was suspected. The investigations took the form of a
questionnaire, the lay-out of which varied slightly from
country to country; but all questionnaires dealt with:
The specimens (blood and/or milk) collected at the time of
suspicion were submitted to the national FMD reference
laboratories for examination and the outcome of
the examinations (time of reply and result) was given in the
scenario. Two countries, Finland and Iceland, took
the opportunity to test transport of samples by air to the
– duration of infection in the herd
– potential source of infection
– the movement of animals, persons, vehicles and
substances (milk, meat, wool, slurry, manure, animal feed,
etc.) likely to have carried the FMD virus to or from the
herd in question.
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Rev. sci. tech. Off. int. Epiz., 27 (3)
When the disease was confirmed in Denmark work was
initiated concerning the determination of the potential
airborne spread of the FMD virus. Data collected at the
infected farm (estimated virus release) and meteorological
data obtained from the Danish Meteorological Institute
were used in established FMD virus airborne spread
models. The results obtained from the models (an
atmospheric long-range dispersion model and an
atmospheric short-range dispersion model) were
communicated to the CVOs and game masters in Finland,
Norway and Sweden.
It is important to ensure that documents produced and
circulated during a simulation exercise are not mixed up
with normal documents. In order to prevent this problem
a printed watermark with the written text ‘EXERCISE’ was
inserted in all exercise documents. In connection with
telephone conversations the caller would start the
conversation with the words ‘This is an exercise’ to avoid
misunderstandings. In two countries the central veterinary
administrations established a special ‘simulation exercise
mail-box’ by using a log system that is part of the Microsoft
Outlook programme.
None of the five countries carried out culling of animals;
but cleaning and disinfection facilities were established for
persons entering and leaving farms. Furthermore, killing
teams were called to some of the farms where outbreaks
were confirmed.
Two countries – Denmark and Finland – prepared a plan
for emergency vaccination against FMD during the
exercise. The plan took into account the criteria listed in
Council Directive 2001/85/EC (3), which include:
– population density of susceptible animals
– predominant species clinically affected
– movement of potentially infected animals and products
out of the established protection zone(s)
– predicted airborne spread of virus from infected
holdings
– suitable vaccine
– origin of the outbreak with regard to traceability
– distribution of outbreaks
– public reaction to stamping out
– economic assessment of competing control strategies.
Furthermore, the logistic aspects of vaccination were
simulated by desk top exercises.
Evaluation of
simulation exercise
The evaluation of the FMD simulation exercise looked at
both inter-Nordic events and national events. The main
topics included in the evaluation process were:
– management, particularly decision making and policy
development
– technical aspects covering disease surveillance,
diagnostic capabilities and capacities, use of FMD airborne
spread models, culling and disposal of animals
– communication
communication
between
countries
and
media
– information transfer with regard to epidemiological data
and use of Geographical Information Systems (GIS)
– resources in relation to personnel and equipment
– lessons learnt during the exercise, i.e. what went well
and what went wrong.
An external evaluator carried out the evaluation of the
inter-Nordic events. An evaluation questionnaire
containing 82 questions covering the main topics listed
above was developed and used by all countries during the
evaluation process. Furthermore, the individual countries
evaluated the national events by use of ‘wash-up meetings’
with stakeholders and observers who had participated in
the exercise and also by use of specially designed
questionnaires.
The outcome of the evaluation was that the FMD
simulation exercise from 19 to 23 September 2005 was
considered to have been a very valuable exercise. Feedback
from participants indicated that the objectives of the
exercise had been met; the scenario had been considered
realistic and had taken into account the characteristics of
the different livestock production systems in the five
Nordic countries and contained good challenges for the
participants. Furthermore, a high level of commitment was
noted during both the preparation and the conduct of the
simulation exercise.
With regard to the elements of the exercise calling for
cross-border collaboration between the five countries, the
following observations and conclusions were made:
– bi-weekly telephone conferences between the CVOs
were useful for ensuring good information exchange. At an
early stage of an actual crisis these conferences should be
scheduled at fixed time-points;
– during epidemiological investigations all five countries
made use of the epidemiological questionnaires available
in the contingency plans. When required, the results from
the investigations were rapidly transmitted to
neighbouring countries by phone, fax and email;
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– there was good use of FMD virus airborne spread
models. Maps detailing potential airborne spread after
confirmation of the first FMD outbreak were available in
the four countries using the models (Denmark, Finland,
Norway and Sweden) within a period of 2 h to 12 h;
– good and on-going collaboration with air carriers is
necessary for ensuring quick and efficient international
transport of samples containing contagious material for
diagnostic examination;
– the planned adoption of a common Nordic policy with
regard to transport of horses and hunting dogs was more
time consuming than anticipated. It proved impossible to
include this activity in the scenario and no common policy
was adopted during the exercise;
– the exercise revealed that two out of the five countries
had arrangements in place (draft contracts, insurance
policy) for recruitment of veterinarians from other Nordic
countries;
– GIS was used during the exercise to delineate protection
and surveillance zones. Three countries were able to
transfer maps of the zones to all countries. The application
of GIS ensured that information on established zones could
be communicated to neighbouring countries easily. If a
zone included parts of the territory of two countries maps
could be consulted easily and the system enhanced the
administration of such cross-border zones;
– the handling of the FMD suspicion in a flock of reindeer
in Finland demonstrated that there was good cooperation
between the veterinary administrations responsible for the
health of reindeer in the Nordic countries and gave an
opportunity to apply the FMD contingency plan in
reindeer husbandry areas.
Discussion
Simulation exercises have been used for a number of years
by public institutions and certain private companies. With
regard to public institutions, the exercises may simulate
very different situations, such as airport disasters,
biological terrorism, hurricanes and train fires; simulation
exercises, however, may also be an integrated part of a
university training programme (1, 5). Whatever the topic
covered by the exercise, the ultimate goal of conducting
simulation exercises is basically the same: to ensure an
adequate level of preparedness, in terms of procedures and
staff, to manage a real crisis. Within the area of animal
health, simulation exercises have in recent years
particularly focused on the OIE former List A diseases such
as FMD, classical swine fever (CSF) and avian influenza.
A record of simulation exercises conducted since 2001 by
European Countries has been published by T. Murray (4)
Rev. sci. tech. Off. int. Epiz., 27 (3)
and since 2002 the OIE has systematically published
information on simulation exercises conducted by
OIE Member Countries (7). In 2005 and 2006 the OIE
provided information on the implementation of 13 and
23 simulation exercises, respectively. The Central
Veterinary Administration responsible for the preparation
of documents related to a simulation exercise may make
the documents available on their website; an example is
documents related to Exercise Hawthorn, an exercise
conducted in 2006 in the United Kingdom to test the
government’s avian influenza emergency preparedness (6).
The importance the EU gives to implementation of
simulation exercises in the area of animal health has been
highlighted in several acts of legislation (2, 3), but also by
the fact that disease simulation exercises are now a
requirement for candidate countries. Prior to the EU
enlargements in 2004 and 2007, when the number of
countries joining the Community was ten and two,
respectively, all 12 candidate countries performed at least
one simulation exercise involving large livestock (an FMD
or CSF exercise) and one exercise involving poultry (a
Newcastle disease or avian influenza exercise).
Conclusions
The inter-Nordic FMD simulation exercise has, during the
different stages of preparation, implementation and
evaluation, created an important and valuable network
between the veterinary administrations of the Nordic
countries. It tested the established contingency plan of
each country and showed that in principle their plans were
satisfactory, although some minor adjustments should be
incorporated. It has shown that the structure of the
competent authorities of the five countries allows for
proper functioning of simulation exercises over several
days, with steadily rising pressure on staff with regard to
challenges, functions and duties and to the numerous links
to stakeholders and the outside society. An exercise can be
organised by a small group of game masters with simple
but highly effective measures.
Acknowledgements
The authors would like to express sincere thanks to the
Chief Veterinary Officers of Denmark, Finland, Iceland,
Norway and Sweden and staff members of their National
Veterinary Services for the excellent cooperation during the
preparation, implementation and evaluation of the interNordic FMD simulation exercise and in addition for their
valuable contributions in the preparation of this article.
The authors are particularly grateful to the Nordic Council
for its financial support for the preparation and
implementation of the exercise.
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Rev. sci. tech. Off. int. Epiz., 27 (3)
Exercice de simulation de la fièvre
aphteuse dans cinq pays d’Europe du Nord
J.M. Westergaard, C.B. Andersen & S. Mortensen
Résumé
Les exercices de simulation sont un outil fort apprécié pour tester les plans
d’urgence visant l’éradication et la lutte contre la propagation rapide
de maladies telles que la fièvre aphteuse, la peste porcine classique et
l’influenza aviaire. Un exercice de simulation a été conduit en 2005 par cinq pays
d’Europe du Nord afin de tester les plans d’urgence contre la fièvre aphteuse
élaborés respectivement au Danemark, en Finlande, en Islande, en Norvège et
en Suède. Les Administrations vétérinaires centrales de ces cinq pays ont
préparé conjointement un scénario faisant intervenir près de 40 élevages,
4 troupeaux de rennes, 6 abattoirs et environ 500 personnes. Un tableur Excel
décrivant le déroulement des opérations ainsi que le calendrier à suivre durant
l’exercice a permis d’en suivre la progression. L’évaluation de l’exercice visait
autant les activités inter-nordiques que celles conduites par chaque pays
individuellement.
Mots-clés
Activité inter-nordique – Collaboration transfrontalière – Exercice de simulation – Fièvre
aphteuse – Santé animale.
Simulación de un episodio de fiebre aftosa
con participación de los cinco países nórdicos
J.M. Westergaard, C.B. Andersen & S. Mortensen
Resumen
En general se considera que los ejercicios de simulación constituyen
un instrumento muy útil para ensayar los planes de contingencia destinados a
contener y erradicar enfermedades animales que se extiendan con rapidez,
como por ejemplo la fiebre aftosa, la peste porcina clásica o la influenza aviar.
En 2005 se llevó a cabo en los cinco países nórdicos uno de tales ejercicios, con
el objetivo de poner a prueba los planes nacionales de contingencia contra la
fiebre aftosa de Dinamarca, Finlandia, Islandia, Noruega y Suecia. Los
organismos veterinarios centrales de los cinco países prepararon
conjuntamente una hipótesis de trabajo en la que de un modo u otro resultaban
afectadas 40 explotaciones ganaderas, 4 rebaños de renos, 6 mataderos y
aproximadamente 500 personas. Para asegurar el seguimiento del proceso
resultó muy útil contar con una hoja de cálculo Excel que contenía información
sobre todos los acontecimientos que debían producirse, junto con el calendario
que convenía seguir durante el ejercicio. Al evaluar la simulación se tuvieron en
cuenta tanto las actividades conjuntas como las de cada país por separado.
Palabras clave
Actividad conjunta entre países nórdicos – Colaboración transfronteriza – Fiebre aftosa
– Sanidad animal – Simulación.
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Rev. sci. tech. Off. int. Epiz., 27 (3)
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